Feature Article

Swimmer’s ear and differential diagnoses

Melville da Cruz



Swimmer’s ear (acute diffuse otitis externa) is a common problem in clinical practice and treatment is based on simple principles.

Key Points

  • Acute diffuse otitis externa or swimmer’s ear is a common problem in general and specialist practice.
  • Underlying causes of acute diffuse otitis externa are most often bacterial or fungal infections of the external canal following water exposure.
  • Most infections can be resolved promptly with simple ear toileting techniques and local application of antibiotic drops and ointments in conjunction with waterproofing.
  • Ear swabs are reserved for patients with recurrent otitis externa, those who are treatment resistant or at-risk patients (those who have diabetes, are immunocompromised or have had previous ear surgery or irradiation).
  • At-risk patients and those with increasing pain, bleeding or failure to respond to simple treatment require referral for specialist assessment.
  • Although cancer of the ear canal is rare, the symptoms are similar to those of otitis externa. A high degree of awareness is therefore required, particularly in patients who respond poorly to treatment for otitis externa.